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Scared new mother needs some reassurance...

Hello all!

My little one is 4 days old. Born at 37 weeks due to Cholestasis. Induction went well and the doctors say she is doing great.

I have had trouble breastfeeding from day 1, her mouth is so small that it seems she only gets the end of my nipple in her mouth which makes it painful to feed her. So I got a nipple shield from the lactation specialist at the hospital, this seems to make it much better. Getting her to latch is a challenge, she fidgets and won't keep her hands out of the way, but when she does seem to latch she feeds well. Some sessions go well and some are frustrating to the point of tears, I suppose this is normal for new moms? I guess we can't get it right first time every time right?

When she is done feeding, sometimes she is tired again, so I burp her ( I rarely get any burps) instead she seems to spit up, mostly before I even start to burp her, or even during, it seems like she is spitting up everything she eats but I read it just looks like a lot?
She also coughs sometimes when she is feeding which freaks me out, I am a new mother and terrified. Any advice on how to reduce the spitting up? How to tell if the latch to the nipple shield is right? Anyone else have the same things going on or have had in the past?

Any advice or reassurance is appreciated. My anxiety is off the scale!

Side note, the doctor says her weight is good and she looks healthy...

Re: Scared new mother needs some reassurance...

I don't think your anxiety should be off the scale. It sounds like you're doing wonderfully well, with maybe a few things that you could tweak but which your baby will probably grow out of with time.

If baby has plenty of diaper output and is gaining weight well, then it doesn't matter how much she spits up because there's plenty staying down in her tummy. Incidentally, babies spit not because they are overfed or because there's something wrong, but because the muscle sphincters which hold stomach contents down are weak in a young baby, just like all her other muscles. Time will take care of the spit-up issue, I promise! Until then, you only need to worry about spit-up if the baby is not gaining weight well, if the spit-up is literally projectile, and if the baby seems in pain when spitting. If you need reassurance about the amount your baby spits up, try pouring an oz of milk on your countertop. (Cow's milk, please, not yours!) You'll see that milk spread out like crazy, and it will look like a lot more than a single oz.

Some frustrating feedings are very normal at this point. You might want to try swaddling baby so that she can't push the breast with her little hands, and you also may want to try to latch her on before she's really hungry. Hungry babies get frantic and become difficult to latch. If you miss that "I'm hungry but not yet frantic" window, and baby is squalling and thrashing, try offering her your pinky finger to suck, with nail held down towards her tongue instead of up towards the delicate flesh of the palate. A few seconds of sucking on your finger might calm her and remind her that sucking is the solution to her distress.

Coughing during feeding is baby's way of protecting her airway, and it's a good thing when baby is able to do that. Swallowing and eating require a very complex series of muscle movements, and young babies are often a little uncoordinated in this department. But they get better at it! Often what is going on is that a young, small baby is struggling with a rapid milk flow. It can be like drinking from a firehose- the milk lets down and WHOOOOSHHHH! This is another problem that will improve with time, as your baby gets better able to control milk flow and your milk supply adjusts so that it's meeting baby's needs pretty exactly, ith out a lot left over to cause rapid letdowns.

The two things I'd really like you to do are one, to think about seeing a lactation consultant, preferably an IBCLC, for help with your latch, and two, to experiment with nursing without the shield from time to time. Eventually you're going to want to wean from that thing!

Re: Scared new mother needs some reassurance...

Thank you so much for the reply! I feel so much better knowing that she is still getting what she needs. I would love to stop using the shield but without it, there is no latch and then there is no lunch for her, this leaves her crying and upset and it breaks my heart, it is also so painful without the shield, I think my nipple is rather large for her tiny mouth, that and I just don't seem to ever get the right latch no matter how many times I take her off and reposition. When I look down as she is feeding, I see her pretty much just sucking on the nipple itself, not the nipple and part of the areola as suggested by most people. I feel like a failure in the beastfeeding department.

Last night was a challenge. Here comes my other issue. All the books and experts say to feed your newborn every 2 to 4 hours, well my little girl sleeps a lot, sometimes not waking for up to 5 or 6 hours, I got worried about it so last night I woke her to feed before putting her down for the night and my husband and I ended up having a terrible night with her. Any one else have a little one that can sleep a ton. Do you wake them to feed or wait for them to let you know they are hungry? I am lost on this one.

I got told yesturday that a Lactation Consultant was going to contact me, could be any time.

EDIT: Small side question, when I pumped this morning after her morning feed I got almost 2oz I believe, maybe 50ml. Is this a good amount? Does she get more or less than that when on the breast? Last night I let my husband feed her so I pumped just about 2oz, when she was done with it she was still looking for more. Am I going to struggle to keep up with her and is she going to go hungry? This would break my heart...

Re: Scared new mother needs some reassurance...

Welcome haleysmum! I have three children, and I also had Cholestasis with my oldest and my youngest. They were both born via c-section at 37 weeks. They were both little and had latch issues early on, and I had to use a nipple shield with my oldest. So I know where you are coming from! I hope the itching has stopped for you, I personally found that a much needed relief!

Mommal had great suggestions for you after your first post, so I am going to address your last.

All the books and experts say to feed your newborn every 2 to 4 hours, well my little girl sleeps a lot, sometimes not waking for up to 5 or 6 hours, I got worried about it so last night I woke her to feed before putting her down for the night and my husband and I ended up having a terrible night with her. Any one else have a little one that can sleep a ton. Do you wake them to feed or wait for them to let you know they are hungry? I am lost on this one.

It is confusing! I will try to walk you through it...first, All the experts do NOT say this. LLL has been expert in breastfeeding for 55+ years, and at LLL, we recommend that a baby is fed on cue aka fed on request-more on recognizing an infants cues in a minute. The scientific evidence in support of cue feeding breastfed babies is very strong.

BUT, for a very young infant under two weeks, especially if mom had an epidural or medications during or after delivery, baby may be very sleepy and only cue feeding may not work, because baby is so sleepy and not cueing enough. An infant 'should' be nursing about 10-12 OR MORE times in 24 hours.

So how to make that work with a sleepy baby? The answer is, cue feed when baby is awake-baby may want to nurse every hour or even more often- AND wake baby to nurse if they are sleeping longer than 2-3 hours at a stretch, depending on how much baby nursed prior to going to sleep. Just so it all adds up to more than 10 times a day and baby is pooping and gaining ok.

So instead of thinking about 'baby must nurse every two to 3 hours, think 'how many times a day total has baby nursed. Remember, you cannot nurse to often, but you can nurse to little.

You may find that your baby takers a long sleep stretch once a day. Maybe 4-6 hours. That happens sometimes and it can be ok if it is only once a day. BUT, while you are trying to figure things out, I would suggest don't let baby go longer than 4 hours without nursing.

Nursing frequently helps everything. It helps baby get enough milk. It helps your milk production. It helps keep the breast softer which helps with latch. And there is no down side to nursing very frequently.

Waking a sleepy baby to nurse is challenging, but you will soon find a rhythm that works for baby. And baby will soon start being a more frequent waker on her own.

Re: Scared new mother needs some reassurance...

Thank you for your input.

At the moment the itching has stopped, I am still paranoid it could come back lol.

When I wake my LO for feeding she tends to only feed for ten minutes or so at a time, whereas if I leave her to tell me when she is hungry, normally after she wakes from a sleep, she can nurse for up to 20 minutes. I don't alternate breats, I let her go on one until she stops, I was told it's better that way as she may likely get to the hind milk? Is it normal for her to feed for less time if I'm waking her to feed more frequently?

Re: Scared new mother needs some reassurance...

Hi haleysmum, just wanted to add a suggestion to all the great advice above. It would be better not to pump and give baby bottles at this point. It's easier for LO to drink out of a bottle than the breast, so sometimes babies who get a bottle early on refuse the breast ("nipple confusion.") It's best to wait until you have a well-established breastfeeding relationship - usually at least 4-6 weeks of exclusive nursing - before offering the bottle. There are many ways your husband can be involved in LO's care without giving her a bottle - holding her, rocking her in his arms, etc - my husband used to put our babies skin-to-skin against his bare chest - gives mommy a little break to take a shower or rest while still maintaining the close sensation that babies love! The other reason not to pump at this point is that you want to sync up with your baby. Breastfeeding is all about supply and demand. Your baby generates the demand by suckling when hungry, your breasts make milk to match that supply. Pumping can interfere with that - sometimes pumping is not as good a signal to the breasts to make milk, leading to a decrease in supply, sometimes it creates too strong of a signal and mothers end up with oversupply. There are situations where mothers of newborns need to nurse and pump, but if there isn't a specific reason to do so, it's better to just nurse at the beginning. This will also help baby learn the motor skills she needs to get really good at nursing.

Regarding your question of both breasts vs one - if baby drifts off after the first breast, use some of the techniques mentioned in the "waking sleeping baby" link (one strategy I like is to change diapers between breasts), then offer the second breast. The overall quantity of milk a baby consumes is more important than whether it's "foremilk" or "hindmilk" (actually a somewhat arbitrary distinction - there's a gradual, continuous change in milk content from beginning to end, not a discrete point at which milk changes from one thing to the other.)

Re: Scared new mother needs some reassurance...

Yes, it's normal for her to take shorter feeds if the feedings are more frequent. But keep in mind that babies are unpredictable little creatures and sometimes your LO will feed for more time, or less time, for absolutely no discernible reason.

Are you offering both breasts at a feeding, or just one at a time? Your LO is just 5 days old and at this point your primary concern should be building a good supply, not worrying so much about foremilk/hindmilk ratios. This doesn't mean switching breasts after some artificially determined amount of time- it means allowing baby unrestricted time on the first breast, and then offering the second breast, as a dessert course, once she comes off the first breast.

Re: Scared new mother needs some reassurance...

Feeding is extremely painful for me at the moment, one of the reasons I pump a little bit. Once a day really. I suppose I do it also for reassurance, when she is on the breast I don't know how much she is getting and keeping down, when I bottle feed her, I can see how much she takes..

EDIT: My next problem is her sleeping, she is a great baby, she can sleep for 6 hours non stop, this worries me, all the books say to take cues from her, watch her signs of wanting to feed and not the clock. Then others say you must wake your baby to feed every 2 to 4 hours. I would hate to be woken up and told to eat, why would she like it? Is sleeping a lot a good thing? Do you wake your baby to feed or let him/her sleep until they fel hungry enough to let you know?

Re: Scared new mother needs some reassurance...

I understand the desire to see how much she's getting, but it's actually a very poor measure of how much she gets at the breast. And if you're having trouble with latch, the last thing you want to do is at an artificial nipple to the picture. Trust yourself, and watch your baby's output (pees and poops) and growth. If those are going well, you don't need to worry about how many ounces she's taking in.

With respect to sleeping - at this point, babies need to eat very frequently, day and night. It is totally normal - they are not yet like adults with their sleeping patterns and have very tiny stomachs. It really is OK to wake your baby if they sleep too long when they are this young.